Are crutches necessary with a cam (controlled ankle movement) boot for a 5th metatarsal fracture?

Crutches with CAM Boot for 5th Metatarsal Fracture

Crutches are not routinely necessary when using a CAM boot for most 5th metatarsal fractures, as the boot itself provides adequate offloading and allows protected weight-bearing as tolerated. 1, 2

Weight-Bearing Recommendations by Fracture Type

The need for crutches depends on the specific location and type of 5th metatarsal fracture:

Tuberosity Avulsion Fractures (Most Common)

• Weight-bearing as tolerated immediately in a short leg walking boot after initial compressive dressing 2
• Crutches are optional for comfort during the first few days but not medically required 3, 4
• Patients can progress mobility as pain allows without compromising healing 4
• Treatment duration: 2 weeks in boot, then transition to rigid-sole shoe 2

Jones Fractures (Zone 2 - Higher Risk)

• Non-weight-bearing with crutches is mandatory for 6-8 weeks in a short leg cast 2
• This fracture type has significantly higher nonunion rates (15-30% with conservative treatment) due to poor retrograde blood supply 5
• Healing time extends to 10-12 weeks in many cases 2
• This is the critical exception where crutches are absolutely required 2

Metatarsal Shaft Fractures

• Initial non-weight-bearing with posterior splint and crutches 2
• Transition to short leg walking boot for 4-6 weeks with progressive weight-bearing 2
• Crutches needed initially, then weaned as tolerated

Evidence Supporting CAM Boot Effectiveness

The CAM walker boot significantly reduces pressure at the 5th metatarsal base compared to other devices:

• Produces lower peak pressure during walking and heel-walking versus postoperative sandals (P < .01) 1
• Reduces contact pressures more effectively than standard athletic shoes during heel-walking (P < .001) 1
• The boot itself provides sufficient offloading without requiring complete non-weight-bearing for most fracture types 1

Clinical Pitfalls to Avoid

Do not assume all 5th metatarsal fractures require the same treatment:

• Zone 2 (Jones) fractures are the watershed exception requiring strict non-weight-bearing with crutches 5, 2
• Tuberosity avulsions heal reliably with immediate protected weight-bearing 3, 4
• Misidentifying fracture location leads to either over-restriction (unnecessary crutches for avulsions) or under-treatment (allowing weight-bearing on Jones fractures)

Verify fracture location on radiographs with three standard views (AP, lateral, mortise) to properly classify the injury 6

Practical Management Algorithm

1. Confirm fracture type radiographically 6
2. If tuberosity avulsion: CAM boot with weight-bearing as tolerated, crutches optional for comfort only 2, 3
3. If Jones fracture (zone 2): Mandatory non-weight-bearing with crutches for minimum 6-8 weeks 2
4. If shaft fracture: Initial crutches with non-weight-bearing, progressive weight-bearing in boot over 4-6 weeks 2

Outcomes Data

Studies demonstrate excellent healing without routine crutch use for avulsion fractures:

• 100% radiographic union by 65 days (average 44 days) with soft dressing and weight-bearing as tolerated 3
• Patients treated with protected weight-bearing returned to full activity in 33 days versus 46 days with rigid immobilization 3
• Only 1% required operative intervention for delayed/nonunion when discharged with immediate weight-bearing instructions 4

The key distinction is fracture location—tuberosity avulsions do not require crutches, while Jones fractures absolutely do. 2